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We propose that there should be a national colorectal cancer screening programme in the UK, and that there is a good case to base it on a single flexible sigmoidoscopy (FS) at approximately 60 years of age, possibly supplemented by faecal occult blood testing (FOBT) after age 60 years, predominantly for the detection of early proximal cancers.
CASE FOR SCREENING
There is no longer doubt that screening is an effective method of reducing colorectal cancer (CRC) incidence and mortality rates. The US Preventive Services Task Force1 recently reviewed the evidence and gave a grade A recommendation that all men and women over the age of 50 years should be screened for CRC. In the UK, the Department of Health has demonstrated its commitment to CRC screening by funding a national demonstration pilot to assess the feasibility and acceptability of FOBT in the general population.2 Together with the MRC it is also funding a randomised trial of a single FS screen offered at around age 60 years with colonoscopy for those found at FS to have high risk adenomas. The trial recently reported3 that FS is acceptable, feasible, and safe but has yet to report on the magnitude and duration of efficacy. The FOBT pilot was completed in mid-2002 and results are due to be presented to ministers in early 2003. Colonoscopy is not considered a feasible option for mass screening in the UK because of the personal commitment required of the screenee, the risks of perforation, and manpower issues.
GOAL FOR SCREENING: PREVENTION IS BETTER THAN EARLY DETECTION
The FOBT regimen under consideration in …